Percutaneous Computed Tomography-Guided Transdiscal Low Cervical Cordotomy for Cancer Pain as a Method to Avoid Sleep Apnea

OBJECTIVE: Study of percutaneous computed tomography (CT)-guided transdiscal low cervical cordotomy undertaken to treat pain in cancer patients. METHODS: At the Department of Neurosurgery, Ain Shams University, Cairo, Egypt, 8 cancer pain patients, with either impaired pulmonary function or a previous cordotomy on an opposite side (sleep apnea was a feared complication) that prevented the possibility of undergoing a C(1-2) cordotomy, underwent a percutaneous CT-guided transdiscal low cervical cordotomy (C(4-5) or C(5-6)) to treat cancer pain. RESULTS: Seven patients experienced initial improvement. One patient re-experienced pain within 2 weeks and 1 patient experienced no pain relief. In 6 patients in whom the cordotomy procedure was completed, satisfactory or complete pain relief, throughout a 6-month follow-up period was reported. In contrast, in 2 patients in whom the cordotomy was not completed there was no persistent pain relief. CONCLUSION: Percutaneous CT-guided cordotomy remains a successful procedure to control pain in cancer patients, and is an affordable viable option under circumstances where economic disadvantage is an overriding determinate.